Wednesday, July 27, 2011

People who’ve been involved with ICD-10 assessment and remediation projects gain a quick understanding of the depth and breadth of the challenge they are facing. While the transition to ICD-10 offers many strategic opportunities for payers and providers, the immediate challenge is to achieve compliance while maintaining the status quo of existing business processes and financials through the Oct 2013 transition date.

This post identifies some of the primary areas of focus for achieving neutrality in your ICD-10 solution design. Also included are key challenges to overcome in order to achieve neutrality in your ICD-10 solution design.

Focus Areas

1.Financial Neutrality

Financial Neutrality means maintaining reasonably equivalent financial outcomes with your trading partners both before and after the conversion to ICD-10 is completed. Member benefits and provider contracting/pricing are two key business areas to neutralize.

2.Process Stabilization

Process Stabilization means that your internal and external business processes can be carried out on a consistent basis before and after the transition date. Key areas to ensure stabilization include Case Management, Utilization Management, Disease Management and Reporting.

Challenges

1.Defining a Remediation Solution for existing business processes and software components that maintain existing operational performance and financial metrics.

2.Ensuring that business processes, software components and trading partner interactions are predictable and consistent.

3.Defining a framework to ensure integrity of the solution design BEFORE and AFTER the transition date.

4.Identifying and creating contingency plans and the gates and levers that trigger these plans.

In future posts, I’ll share additional knowledge, perspective and insight into the topic of solution design neutrality with the hope that others share their ideas, concerns and perceptions. Like a good relationship, a little give and take goes a long way toward pleasing everyone involved.

Thursday, July 21, 2011

The hubbub around ICD-10 seems to be focused on the provider-side of the provider-payer equation; specifically in regards to how ICD-10 impacts clinical documentation, claim coding and reimbursement. A whole host of education, training and awareness-building products and services are being offered (and pushed) at providers by a wide range of companies including traditional healthcare IT vendors, mainstream education/training firms, various associations like AAPC and AHIMA and even some old-school accounting firms.

But there appears to be a dearth of similar offerings targeted at healthcare payer staff charged with assessing and remediating their business processes and software systems.What would an ICD-10 Awareness Program for hHalthcare Payers Include?1. The usual overview of ICD-10 code structure and differences from ICD-9.

2.An overview of other codes impacted by ICD-10 including DRG’s, MDC’s, and HCC’s.

3. Enumeration and high-level review of payer business processes and applications impacted by ICD-10 and related codes.

I think a payer-focused ICD-10 Awareness program would help leverage existing resources, lessen dependency on expensive consulting resources who often learn on the job at the clients expense and lead to better overall outcomes.Who’s out there that can provide this needed service?

In order to provide the greatest value and to mix things up on a regular basis, I will respond to requests for information on ICD-10 and other health care IT topics. For instance, in regards to ICD-10,

What is your current biggest challenge?

What is your greatest risk?

What are the key questions you as a provider have for a payer? and vice-versa?

What specific areas of the assessment or remediation process would you like more information about?